RV-001 · SP-PER(HW+FA)

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Study date: 2026 (date redacted).   Sex: Female.   Age: 65+ (DOB redacted).

Examined regions & views: Hands/wrists — bilateral multiplanar series (PA, oblique, functional projections); feet/ankles — bilateral multiplanar series (AP, oblique, lateral, mortise/axial forefoot projections).

Image quality: Good diagnostic quality for bone, joint spaces, periarticular soft tissues.

Findings — Right hand / wrist

Bones and alignment

• No acute fracture or gross malalignment.
• Carpal alignment preserved; no collapse or dissociation.
• Mild periarticular demineralization around MCPs and carpus compared with diaphyseal bone.

Joints

• MCP 1–5: Joint spaces preserved. Cortical margins smooth. No discrete marginal erosions or subluxations.
• PIP 2–5: Joint spaces largely preserved; only minimal early narrowing at PIP 3–4. No erosions.
• DIP 2–5: Mild non-uniform joint space narrowing with small marginal osteophytes and subtle subchondral sclerosis, compatible with mild degenerative change. No central erosions or tuft resorption.
• Thumb IP/MCP: Mild osteophytes and early narrowing at IP; MCP preserved.
• Radiocarpal / midcarpal joints: Joint spaces preserved. No carpal erosions or ankylosis.
• First CMC / STT: Mild osteophytes and early joint space narrowing at first CMC; STT joint preserved.

Soft tissues

• Diffuse soft-tissue prominence around MCP 2–3 and along the dorsal hand compared with expected contour, compatible with active synovitis/tenosynovitis in the clinical setting.
• Mild fullness around the radiocarpal joint without calcified bodies or tophus.
• No periosteal new bone formation or aggressive soft-tissue mass.

Findings — Left hand / wrist

Bones and alignment

• No acute fracture or malalignment.
• Carpal alignment preserved.
• Mild periarticular demineralization at MCPs and carpus.

Joints

• MCP 1–5: Joint spaces preserved; no discrete marginal erosions or subluxations.
• PIP 2–5: Joint spaces preserved with only minimal early narrowing at PIP 3–4; no erosions.
• DIP 2–5: Mild non-uniform narrowing with small marginal osteophytes and subtle subchondral sclerosis, again consistent with mild degenerative change. No pencil-in-cup deformity, central erosions, or tuft resorption.
• Thumb IP/MCP: Mild osteophytes and early narrowing at IP; MCP preserved.
• Radiocarpal / midcarpal joints: Joint spaces preserved; no erosions or ankylosis.
• First CMC / STT: Mild osteophytes and early narrowing at first CMC; STT preserved.

Soft tissues

• Visible dorsal soft-tissue prominence about the MCP region and wrist, compatible with synovitis/tenosynovitis when correlated with exam.
• No focal calcified deposits or mass.
• No periosteal reaction.

Findings — Right foot / ankle

Bones and alignment

• No acute fracture or dislocation.
• Hindfoot and midfoot alignment preserved.

Joints

• First MTP: Mild joint space narrowing with small marginal osteophytes and mild subchondral sclerosis (degenerative). No erosions or collapse.
• Lesser MTP 2–5: Joint spaces preserved; no erosions or subluxations.
• IP joints of toes: Mild scattered osteophytes and minimal joint space narrowing, degenerative in appearance.
• Midfoot / tarsometatarsal joints: Joint spaces preserved; no erosions.
• Tibiotalar and subtalar joints: Joint spaces maintained; no erosions or ankylosis.

Soft tissues and entheses

• Diffuse soft-tissue fullness over the forefoot, particularly along the dorsal MTP region, compatible with clinical inflammation.
• Small plantar calcaneal spur and early enthesophyte at the Achilles insertion, consistent with chronic heel enthesopathy.
• No soft-tissue gas, foreign body, or aggressive mass.

Findings — Left foot / ankle

Bones and alignment

• No acute fracture or dislocation.
• Overall alignment preserved.

Joints

• First MTP: Mild joint space narrowing with marginal osteophytes and mild subchondral sclerosis, similar to the right, compatible with mild osteoarthrosis.
• Lesser MTP 2–5: Joint spaces preserved; no erosions or subluxations.
• IP joints of toes: Mild osteophytes and minimal joint space narrowing, degenerative pattern.
• Midfoot / tarsometatarsal joints: Joint spaces preserved; no erosions.
• Tibiotalar and subtalar joints: Joint spaces maintained; no erosions or ankylosis.

Soft tissues and entheses

• Dorsal soft-tissue prominence over the forefoot/MTP region, compatible with inflammatory swelling in the appropriate clinical context.
• Small plantar calcaneal spur and mild Achilles insertion enthesophyte.
• No aggressive soft-tissue abnormality.

Global inflammatory / erosive screen (hands and feet)

• Mild periarticular demineralization at MCPs and wrists.
• Radiographically visible soft-tissue swelling around MCPs, wrists, and dorsal forefeet, concordant with clinical synovitis/tenosynovitis and MTP involvement.
• No definite marginal, central, or intra-articular erosions identified in hands, wrists, feet, or ankles.
• No ankylosis, pencil-in-cup deformity, tuft resorption, or bulky periosteal new bone to suggest advanced psoriatic arthropathy.

Comparison

No prior radiographs of hands, wrists, feet, or ankles are available; interval progression cannot be assessed.

Impression

1. Hands/wrists: Radiographic evidence of periarticular soft-tissue swelling around MCPs and wrists bilaterally with mild periarticular demineralization, supporting clinically active inflammatory arthropathy (in this patient with psoriasis and documented synovitis/tenosynovitis). Coexistent mild degenerative change at the DIP joints and thumb IP/first CMC joints, without erosions or deformity. No discrete marginal erosions, carpal collapse, or joint ankylosis at this time.
2. Feet/ankles: Dorsal soft-tissue prominence over the MTP regions bilaterally, compatible with inflammatory involvement of the forefeet in the clinical setting. Mild degenerative change at the first MTP joints and scattered IP joints of the toes, without erosive or deforming features. Small bilateral plantar calcaneal spurs and mild Achilles insertion enthesophytes, consistent with chronic heel enthesopathy.
3. Overall structural pattern: Imaging demonstrates soft-tissue and periarticular changes that support active inflammatory/enthesopathic disease in a psoriatic patient, but without radiographically established erosive or deforming arthropathy. Structural degenerative changes are mild and largely confined to DIP/IP and first CMC/MTP regions.

Pattern tag (structural): Inflammatory-compatible soft-tissue and periarticular change with mild, coexisting degenerative arthropathy; no erosive/destructive psoriatic pattern identified on this study.

EMR-ready summary

Bilateral hands/wrists and feet/ankles show periarticular soft-tissue swelling and mild periarticular demineralization at MCPs, wrists, and dorsal forefeet, supporting clinically active inflammatory/enthesopathic disease in this psoriatic patient. Structural damage is limited to mild coexisting OA at DIP/IP and first CMC/first MTP joints, with no definite erosions, ankylosis, or deformity to date. Pattern: inflammatory-compatible soft-tissue/periarticular change with mild degenerative overlap; no radiographic erosive psoriatic arthropathy yet demonstrated.

Header

Patient: female, 65+ (DOB redacted).   Study date: 2026 (date redacted).

Regions: Bilateral hands/wrists; bilateral feet/ankles.

Projections: Hands/wrists — bilateral PA hand views including wrists and distal forearms, oblique/semi-pronated hand views, functional lateral (“OK”) views, and focused PA/oblique wrist views. Feet/ankles — bilateral AP and oblique foot views, lateral foot views, and AP/mortise-type ankle views.

Technical quality: Positioning and exposure adequate; no motion or hardware artifact significantly limiting evaluation.

Findings — Hands and wrists

Right hand/wrist

• Soft tissues: Fusiform soft-tissue prominence along the fingers, most evident around MCP/PIP 2–4 and along the proximal phalanges, compatible with synovitis and/or tenosynovitis. Mild soft-tissue fullness about the dorsal and radial wrist.
• Bones and joints: Mild periarticular demineralization. MCP, PIP, and DIP joint spaces overall preserved without definite marginal erosions, collapse, or ankylosis. Carpal alignment maintained; no carpal collapse or subluxation.
• Degenerative changes: Small marginal osteophytes at several DIP joints with very mild joint-space narrowing. Early osteoarthritic change at the first CMC joint with slight narrowing and tiny osteophytes. No chondrocalcinosis.

Left hand/wrist

• Soft tissues: Similar but slightly less pronounced fusiform soft-tissue prominence around several MCP and PIP joints. No discrete soft-tissue calcifications.
• Bones and joints: Overall mineralization and joint spaces preserved; no definite marginal erosions, subchondral cysts, or articular collapse. Carpal alignment normal; no fusion or advanced degenerative change.
• Degenerative changes: Mild osteoarthritic change at the first CMC joint and scattered small DIP osteophytes, comparable to the right side. No chondrocalcinosis.

Findings — Feet and ankles

Right foot/ankle

• Forefoot: Mild hallux valgus with medial bunion-type prominence at the first metatarsal head. First MTP joint with mild joint-space narrowing, small marginal osteophytes, and minimal subchondral sclerosis, compatible with mild osteoarthritis. Lesser MTP joints with preserved joint spaces and no erosions; mild soft-tissue fullness around the 2nd–4th MTP region. Interphalangeal joints with scattered tiny osteophytes and very mild joint-space narrowing, consistent with early osteoarthritis.
• Midfoot and hindfoot: Tarsometatarsal and midfoot joint spaces preserved without erosions or subchondral collapse. Subtalar and tibiotalar joint spaces maintained with smooth articular surfaces. Small plantar calcaneal spur; no prominent Achilles insertion enthesophyte.
• Soft tissues: Diffuse mild soft-tissue thickening along the medial forefoot and plantar aspect. No soft-tissue gas or radiopaque foreign body.

Left foot/ankle

• Forefoot: Mild hallux valgus with small osteophytes and mild joint-space narrowing at the first MTP joint. Lesser MTP joints with preserved joint spaces and no definite marginal erosions. Interphalangeal joints with scattered tiny osteophytes and minimal degenerative narrowing similar to the right side.
• Midfoot and hindfoot: Alignment preserved; no collapse or ankylosis. Tibiotalar and subtalar joint spaces maintained without erosive change. Small plantar calcaneal spur; no significant posterior calcaneal enthesophyte.
• Soft tissues: Mild diffuse soft-tissue fullness around the forefoot. No focal mass, calcification, or ulceration visible on these projections.

No acute fracture, dislocation, or aggressive osseous lesion is identified in the imaged regions.

Impression

• Soft-tissue-predominant inflammatory arthropathy of the hands and feet, reflected by fusiform soft-tissue swelling around multiple MCP, PIP, and MTP joints with mild periarticular demineralization, but without definite marginal erosions, joint-space collapse, or ankylosis at this time.
• Mild coexisting osteoarthritic change involving the first CMC joints and first MTP joints bilaterally, with scattered small DIP and IP osteophytes and minimal joint-space narrowing.
• Preserved ankle and midfoot joint structures bilaterally, apart from small plantar calcaneal spurs; no radiographic evidence of erosive arthropathy, fracture, or destructive bone lesion in the ankles or hindfeet on this study.

Header

Patient: female, 65+ (DOB redacted).   Study date: 2026 (date redacted).

Regions: Bilateral hands/wrists; bilateral feet/ankles.   Modality: XR.

Examined regions & views: Bilateral hands/wrists (PA, oblique, functional lateral hand views, focused PA/oblique wrists); bilateral feet/ankles (AP and oblique feet, lateral feet, AP/mortise-type ankles).

Findings — Hands and wrists (bilateral)

Diffuse fusiform soft-tissue swelling around several MCP and PIP joints, most conspicuous at right MCP/PIP 2–4, with mild periarticular demineralization. Joint spaces at MCP, PIP, and most DIP joints are overall preserved without definite marginal erosions, collapse, or ankylosis. Mild nodal-type osteoarthritis at DIP joints and mild osteoarthritic change at the first CMC and thumb IP joints bilaterally. Carpal alignment preserved; no carpal collapse, fusion, or aggressive osseous lesion.

Findings — Feet and ankles (bilateral)

Mild hallux valgus with bunion-type prominence and mild osteoarthritic changes at the first MTP joints (small osteophytes and mild joint-space narrowing), with scattered tiny osteophytes and minimal joint-space narrowing at some interphalangeal joints. Lesser MTP joints, midfoot, and ankle joints demonstrate preserved joint spaces without definite erosions or destructive change. Small plantar calcaneal spurs bilaterally. Mild soft-tissue fullness over the dorsal and plantar forefeet, without focal mass, gas, or aggressive periosteal reaction.

Comparison

No prior radiographs of the hands, wrists, feet, or ankles are available for comparison.

Impression

• Soft-tissue-predominant inflammatory arthropathy of the hands and feet, suggested by fusiform swelling and mild periarticular demineralization at multiple MCP/PIP/MTP regions, without radiographic erosions, joint collapse, or ankylosis.
• Mild coexisting osteoarthritis, most evident at DIP joints of the hands and first MTP joints of the feet, with scattered small osteophytes and minimal joint-space narrowing.
• Ankle and midfoot joint structures are preserved apart from small plantar calcaneal spurs; no erosive arthropathy, fracture, or aggressive osseous lesion is identified in the imaged regions.